woman and doctor

From the ABCS for heart health to challenges of managing a ZBB (Zero Based Budget), acronyms are a staple in the healthcare industry. While many are commonly recognized, a SNFist is fairly new to the list and proving to be a valuable addition. Healthcare professionals coined the term to describe physicians or advanced practitioners who focus on providing care within a Skilled Nursing Facility (SNF).

“A well-trained SNFist has a background in geriatric medicine and understands the regulatory requirements for nursing home patients. Knowledge of rehabilitation medicine and palliative medicine is also helpful,” explained Priscilla Bade, MD, medical director for Rapid City Regional Hospital.

Becoming a full-time SNFist in 2004, Dr. Bade provides care in seven, and sometimes eight, facilities while also serving as medical director for three facilities. She recommends the education and resources offered by the Society for Post-Acute and Long-Term Care Medicine and encourages medical director certification. Based on a 2009 study, facilities with Certified Medical Directors (CMD) show a 15 percent improvement in quality.

In addition to managing quality of care, medical directors in nursing facilities are often called upon to provide care for residents without an attending physician.

“SNFists bring a specialized knowledge of their practice environment and can practice more efficiently than the provider who may have only a few patients in different nursing homes. They can help assess whether a patient is appropriate for nursing home admission or is ready for discharge from the nursing home,” added Dr. Bade.

Nursing facilities provide short and long-term care to individuals requiring post-acute or palliative care after discharge from the hospital.  This transition of care requires a transfer of personal health information including recent procedures, medication lists and recommended rehabilitation services.

Linda Penisten, program manager for Great Plains QIN“The process of moving an individual to a new care facility can be dangerous. Engaging a SNFist stabilizes the care transition,” commented Linda Penisten, RNC, OTR/L, program manager for Great Plains Quality Innovation Network (QIN). “The consistent oversight of care results in fewer admissions and re-admissions to the hospital and improved outcomes of health, which also reduces healthcare cost.”

According to Centers for Medicare & Medicaid Services (CMS) data from July 1, 2017 to June 30 2018, Rapid City and the surrounding region claim the highest rate in the nation for individuals who stay in their nursing home/residence. In direct relation, admission and readmission rates are decreasing serving as evidence of the impact and success of using the SNFist to improve care transitions.

“Rapid City Regional’s SNFist program started because patients were staying in the hospital extra days because they did not have a doctor to follow them at a nursing home,” Dr. Bade recalled. “As local primary care providers have retired or choose not to follow patients in nursing homes, the program expanded considerably from 24 patients to over 225 in the last three years.”

Retirement and specialty care practices contribute to the provider shortage and rural and medically underserved areas also struggle with limited access to care.

“Communication between practitioners is important to help transitions go smoothly,” emphasized Dr. Bade. “This is important for transfers from the hospital to the nursing facility, and also for transfers from the nursing facility to the community and the care of a different provider.”

Community care transition coalitions across the Great Plains QIN four-state region have focused on methods to improve care transitions and engage all healthcare facilities and community entities involved in the process. Expanding the use of the SNFist is just one example of the best practices discovered through these collaborative efforts. Hear members of Rapid City Regional Health share on Discharge Processes to Assist in the Progression of Care Management and access additional tools and resources on the Great Plains QIN website.